Clinically significant fetomaternal haemorrhage (FMH) is a rare but significant cause of fetal anaemia, often associated with placental or umbilical cord abnormalities and with obstetric manoeuvres and traumatic events. This case follows a 40-year-old woman in her second pregnancy who sustained a severe, unprovoked FMH resulting in an emergency caesarean section at 34+3 weeks' gestation. While her newborn required cardiopulmonary resuscitation and birth and subsequent respiratory support (including an admission to the neonatal intensive care unit), there was a good recovery. This patient's case is of interest due to the lack of major risk factors (including a reassuring fetal growth and well-being scan just two days prior) and raises questions about screening, risk stratification and effective diagnosis. These can assist in identifying women at the highest risk of developing FMH and facilitate rapid diagnosis in order to minimise maternal and neonatal morbidity and mortality.
Lawrence et al. (2026) studied this question.